Summer Treatment Program for Adolescents
ADHD Center for Evaluation and Treatment (ACET)
The Children’s Hospital at the Cleveland Clinic
Program Description
Treatment Goals
The Summer Treatment Program for Adolescents (STPA) provided by the ADHD Center for Evaluation and Treatment
(ACET) of the Children’s Hospital at the Cleveland Clinic is a treatment program, in the context of a camp-like setting, for
adolescents with Attention Deficit Hyperactivity Disorder and related problems. The STPA runs from 8:00 AM until 5:30
PM, Monday-Friday for 7 weeks during the summer at John Carroll University, 20700 North Park Blvd University Heights,
OH 44118. The STPA offers treatment to adolescents between the ages of twelve and fourteen. The three major integrated
and intensive treatment components involve:
•
cognitive-behavior therapy in a summer-day camp setting
•
intensive academic skills training in a classroom designed to simulate a junior-high school setting
•
parent-adolescent communication and problem-solving training designed specifically for adolescents with
ADHD
This cognitive-behavioral and social learning approach focuses on achieving the following goals:
•
to develop the adolescent's problem solving skills, social skills, and the social awareness necessary to enable
him/her to get along better with peers
•
to teach the adolescent appropriate behaviors and to improve his/her learning skills for success in classroom
situations to enhance academic performance and productivity
•
to develop the adolescent's ability to follow through with instructions, to comply with adult requests, and to
complete tasks that he/she may commonly fail to finish;
•
to improve the adolescent's self-esteem by teaching him/her competencies in areas necessary for daily life,
such as interpersonal, academic, recreational, and other task-related areas
•
to teach parents how to develop, reinforce, and maintain these positive changes
•
if appropriate, to evaluate the effects of medication on the adolescent's academic and social functioning in a
natural setting
Daily Activities
Adolescents participate in daily activities that include: classroom training in reading comprehension, note-taking, and
writing skills; interpersonal skills development; athletic activities and skill drills training; a "junior Achievement" style
business meeting; an adolescent issues and problem solving group; and job assignments. Interpersonal skills group
involves discussion and behavioral rehearsal of social skills such as using self-control, making an appropriate complaint,
responding to a complaint, accepting a limit, knowing your feelings, recognizing other's feelings, expressing your feelings,
negotiation, and responding to failure. Recreational activities and skill drills will focus primarily on tennis, soccer, and
basketball. The business meeting follows strict rules of participation, with the purpose of planning, organizing, and
evaluating group-wide business endeavors (i.e., food-sale to raise money for field trips). The adolescent issues group
follows a four-step problem solving approach to age relevant issues (such as peer rejection, drug use, response to authority
figures, and career plans). The peer mediation program involves the adolescents being trained to monitor and resolve
conflicts that arise between younger children during a daily recess period. Job assignments involve the adolescents
spending an hour a day working on a job (e.g., working as a junior counselor, writing for a camp newsletter) for which they
can be paid up to $20 a week. Also, the adolescents may participate in evening food sales that raise money to support
weekly off or on-site field trips that they can earn. In addition, parents will be offered weekly evening group parent
training sessions, during which parents will work on parent-adolescent negotiation and behavioral management skills.
Some sessions will involve both parent and adolescent, and families identify conflictual issues and clarify their expectations
of each other in the presence of a clinical facilitator.
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Behavior Modification
The behavioral component of treatment is designed to give adolescents the opportunity to succeed in challenging, age
appropriate activities. To accomplish this goal, the program is highly structured with an adolescent to staff ratio of 2:1.
Specific skill deficits common in adolescents with ADHD are targeted for intervention. The major features of the behavior
therapy program are immediate feedback, consistency, and clear consequences for behavior. Staff members give feedback
about important interpersonal behaviors (for example, interruptions, rule violations, teasing and verbal abuse) as the
behaviors occur. The adolescents meet regularly with a “primary counselor” who has the responsibility of helping the
adolescent work on individual goals. This precise feedback is made possible by having the counselors periodically rate the
adolescent’s performance and by having the adolescents monitor and record the frequencies of their negative behaviors.
Rewards or consequences for behavior are specified in the Individualized Adolescent Behavior Contracts (IABC). This
contract includes general and individualized criteria for various privileges available in the program and at home.
Individualized goals are based on information gathered during intake interviews and behavior observed in the program.
Behavioral goals in the IABC are evaluated each week and written into contracts signed by the adolescent and his or her
parents.
Daily and weekly reinforcements, for fulfilling contract terms, are provided both in the program and by the adolescent’s
parents. In addition, the STPA provides the adolescents with a weekly monetary reward. The amount of this pay is based
on a combination of an adolescent's success with the IABC, and their performance during jobs and peer mediation. The
IABC has three Levels of Participation with Level 1 having the highest pay and privileges, Level 3 having the least, and
level 2 offering rewards and privileges inferior to Level 1 but superior to Level 3. Each contract has specified criteria for
Levels of Participation reinforced both at home and during program hours. Adolescents who meet criteria for Level 1 for
five consecutive days are promoted to the Honor Level, which has special privileges in the program (e.g. hall passes).
Clinical Staff
Each group is staffed by a lead counselor (i.e., graduate student or recent graduate) and three undergraduate counselors.
Each adolescent is assigned a primary counselor with whom he or she works closely throughout the program. The primary
counselor provides feedback to the youth about his or her behavior, helps negotiate contracts, and takes the majority of
responsibility for managing the day-to-day details of the contract. The lead counselor and clinical supervisor support the
primary counselor's work with the youth. Furthermore, the lead counselor and clinical supervisor (i.e., doctoral-level
psychologist) work closely with parents in the form of contacts at drop-off and pick-up times, signing and modifying
contracts, and conducting the parent-teenager negotiation training. The entire team participates in at least 80 hours of preservice training, and is held to a high degree of accountability through written tests of program knowledge and direct
observation and feedback of clinical skills.
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